541 - Rapid Migration to Telemedicine in a Boston Community Health Center is Associated with Maintenance of Effective Engagement in HIV Care

Background: The COVID-19 pandemic has disrupted many health care activities. The impact of the pandemic on HIV primary care in a Boston community health center (CHC) that has specialized HIV, sexual and gender minority care is analyzed here.

Methods: The CHC has used the Centricity Practice Solution^TM electronic medical record (EMR) system since 1997. The current analyses used data abstracted from the EMR, testing for significant differences in HIV care utilization using the Student t-test for means and chi-square tests for proportions.

Results: There were 2,016 HIV+ patients among 25,606 patients (7.9%) engaged in primary care in 2019. In 2019, HIV+ patients had between 563 and 689 in-person visits per month. On average, monthly visits for HIV care increased (p< 0.0001) in the first two months of 2020 (mean=626, sd=60.1) compared to 2019 (mean=617, sd=40.6), but dropped to 370 and 36 in person visits by HIV+ patients in March and April 2020 respectively 
 (mean=203, sd=236.2; p< 0.0001), when statewide stay-at-home policies were recommended. There were 263 telemedicine visits by HIV+ patients in March and 751 in April, 2020. When telemedicine and in-person visits were combined, mean number of visits per month by HIV+ patients were higher compared to the same two-month period in 2019 (p< .0001). The mean number of plasma HIV RNA viral load (VL) tests performed each month was 279 in 2019 (range 257-312, sd=18.3), versus 219 in March and 274 in April 2020 (mean=246.5, sd=38.9; p< 0.0001). Among those tested, monthly rates of virological suppression ranged from 71-81% in 2019, with 11-20% having VL < 100 copies/ml. Eighty percent had an undetectable VL as their last measurement in 2019; an additional 14% had last VL detectable but < 100 copies/ml. In March and April, 2020, the rates of VL suppression were 77% and 74% and 14% and 18% had VL detectable but < 100 copies/ml, respectively (p=0.209).

Conclusion: The COVID-19 pandemic has led to a significant decrease in in-person visits by HIV+ and other patients at a Boston CHC, but with a rapid migration to the use of telemedicine, patient engagement, as expressed by visits and VL suppression does not appear to be adversely affected